Cradle cap, also called infantile seborrheic dermatitis of the scalp, is a common scalp condition in babies which mostly begins in the first month of life and may be troublesome till the first year. The baby develops diffuse scaling and crusting of the scalp skin most often without itching and the baby is very comfortable and not in pain or any discomfort.
Why does it occur?
The exact reason for cradle cap is not known. Some hormones passed from mother to baby if in excess stimulate extra production of sebum (oil) in the oil glands and hair follicles in the scalp.
A fungus (yeast) called malassezia grows in this sebum and causes crusting.
Sometimes, there could be a secondary bacterial or candida infection in these crusts.
How to identify cradle cap
Cradle cap looks like a lot of dandruff with yellow greasy, scaly patches and crusts diffusely distributed on the scalp. When the scales become flaky and dry, they come off, often with bits of hair attached. But do not worry as once this condition resolves, new hair follicles grow.
It may coexist with atopic dermatitis in which case there will be weeping scales and lots of itching and irritability.
It may spread to the face, eyelids, behind the ears, armpits, diaper area and in between the fingers and toes.
In sick children with severe systemic diseases like histiocytosis and immunodeficiency, cradle cap presents along with multiple other disease symptoms and signs such as high fever, poor weight gain, liver swelling, jaundice etc.
How to treat cradle cap in babies
Cradle cap usually does not require any medical treatment. It clears up on its own in a few months or in some cases stays for up to a year. No lab tests are required to make a diagnosis. When the crusts fall off, new crusts may or may not develop. Following are different ways of managing the cradle cap:
- The best way is to shampoo daily. Let a thick lather form and then wash off. Gently rub the shampoo on the scalp with your fingers or towel. Do not scratch. It is best to use an anti -seborrhoea shampoo containing selenium and zinc with or without topical antifungal agent. If no improvement is seen or if superadded candida infection is suspected, a shampoo containing topical ketoconazole may be prescribed by your doctor. Make sure this shampoo does not enter the baby’s eyes as it can cause irritation.
- Oiling the scalp with coconut or olive oil the previous night and washing off the next day with shampoo is also found to be effective in removing the scales. The oil helps loosen the crusts from the scalp. Leaving the excess oil on the scalp may worsen the crusts.
- Use of soft, small bristles comb to brush hair during shampooing or later helps to remove the loosened scales and crusts. Never try to peel off the crusts as this may cause bleeding.
- The doctor may prescribe a topical steroid (hydrocortisone) cream for resistant cases. This can be applied twice a day for 5 to 7 days.
Take your baby to the doctor if the scaling is too severe, or there is bleeding or it spreads beyond the scalp. Also seek medical advice if the cradle cap is not resolving after good oiling and shampoo.
Do not use over-the-counter cortisone or antifungal creams without consulting a doctor as these products may be toxic when absorbed through the baby’s skin.
This condition is not contagious. It does not occur because of poor hygiene or allergies.
The author is a Consultant Pediatrician at Nanavati Super Speciality Hospital, Mumbai.